THE UNIVERSITY OF HULL The Use of Dramatherapy Techniques Including Role, Play, Movement and Touch in Developing and Extending a Sense of Self and Identity in Young Autistic Adults being a Thesis submitted for the Degree of PhD in the University of Hull by Zoe Alice Bottomley BA (Hons) April 2016 Table of Contents Introduction ......................................................................................................... 1-40 Chapter One ...................................................................................................... 41-73 Identity, Self-Awareness and Development (Empathy, Social Skills and Sense of Self) Chapter Two .................................................................................................... 74-103 Autism, Identity and Self Chapter Three ................................................................................................ 104-140 Dramatherapy and Development of a Sense of Self, Other and Identity Chapter Four ................................................................................................. 141-174 Dramatherapy Practice and a Sense of Self Chapter Five ................................................................................................. 175-216 Autistic Expressions of Self Introduction to Section Two ........................................................................ 217-236 Chapter Six ................................................................................................... 237- 269 Interviews with Autistic Participants Chapter Seven .............................................................................................. 270-305 Interviews with Parents of Autistic Individuals Chapter Eight ................................................................................................ 306-342 Interviews with Dramatherapists Chapter Nine .................................................................................................. 343-361 Conclusion: Dramatherapy and the Autistic Self APPENDICES Appendix A ..................................................................................................... 362-364 Participant Information Sheet Appendix B ................................................................................................... 365-366 Consent Form for Participants Appendix C ................................................................................................... 367-368 Questionnaire for Autistic People and People with Asperger Syndrome Appendix D .................................................................................................. 370-372 Questionnaire for Parents of an Autistic Individual Appendix E .................................................................................................. 373-375 Questionnaire for Dramatherapists BIBLIOGRAPHY ............................................................................................. 376-415 1 Introduction This research seeks to establish the ways in which dramatherapy can be an effective approach for the development of a sense of self, other and identity in autistic people. Through an understanding of the characteristics of autism and the part that an underdeveloped sense of self plays in autistic behaviours, and consideration of autistic expressions of self, fundamental connections are made between the autistic self and key elements of dramatherapy. Consideration of existing autistic self-expressions and the experiences and perspectives of autistic research participants, parents of autistic individuals, and dramatherapists who work with autistic clients, allows for further understanding of the way autistic people choose to express a sense of self, the characteristics of autism and the main features of dramatherapy. Dramatherapy as an oblique approach that offers the opportunity for creative modes of self-expression, and puts the autistic client in the centre of the therapeutic process, allows for exploration of key characteristics of autism, and the acknowledgment and extension of the existing sense of self in autistic individuals, in accordance with the social model of disability. Dramatherapy and Autism Dramatherapy is a relatively new area, particularly from a theoretical point of view, growing in popularity and recognition since the 1960’s when it was first founded. Despite this, the amount of research being done in this area has increased in the past two decades, with many publications from practitioners such as Sue Jennings (1992, 1993, 1994, 1997, 1998, 2009), Phil Jones (1996, 2005, 2 2007, 2008), Ann Cattanach (1992, 1994), Anna Chesner (1995, 1998), Jenny Pearson (1996), Robert Landy (1994, 1996, 2008) and Renée Emunah (1994, 2000, 2009). The majority of research carried out is done by practising dramatherapists and is largely based on practice. Little research into dramatherapy as an approach has been undertaken by academics who are not registered as trained dramatherapists. This has arguably led to much practice based knowledge to the detriment of the consideration of dramatherapy as a concept from an outside academic point of view, from which both the positive and negative aspects of the approach can be reflected upon. Autism is, in contrast, a more widely researched area, with the amount of research steadily increasing since the publication of Leo Kanner’s paper Autistic Disturbances of Affective Contact (1943) in which he became the first person to define the term infantile autism, which then became a classic feature in clinical psychiatry. Much of the literature surrounding autism focuses on scientific and clinical research, and the symptoms that autistic people present from a diagnostic point of view, which suggests that existing research is geared towards recognising the causes of, and finding a cure for, autism. This thesis, however, focuses less on the scientific and clinical aspects of autism, and instead aims to begin to understand autism as a developmental condition that causes an underdevelopment of a sense of self, and how this affects, and is affected by, the main features of autism, such as communication difficulties, problems with social skills and social awareness, sensory sensitivities and special interests and repetitive movements. The research focuses on the understanding of autism not only from the outside in, but also from the perspective of those who are diagnosed as autistic. In order to gain an insight into the world of autistic 3 people, who are described as living within their own inner worlds and experiencing the outside world in a different way to neurotypicals, the views, opinions and experiences of autistic adults are considered through autistic expressions of self and interviews with autistic adults. By so doing, key aspects of autism according to autistic people can be highlighted, including the ways in which they choose to express themselves, which allows for fundamental connections to be made between the autistic self and aspects of dramatherapy in order to argue for the therapeutic potential of dramatherapy for autistic individuals. This research focuses specifically on autistic adults as much research on autism tends to be focused on autistic children. As Howlin (2014) states, it is crucial to recognise that autism is not a childhood disorder. Individuals are adults with autism much longer than they are children with autism. Autism does not disappear at age 18, but unfortunately most interventions and support networks do! Several recent studies and systematic reviews have highlighted both the scarcity of studies of adults with autism and the poor quality of what little intervention research does exist (798). Therefore, it is important to represent autistic adults who cannot conduct their own research, hence why autistic adults have been interviewed within this thesis. This gives autistic participants the opportunity to express themselves within research geared towards a possible intervention through which to develop their sense of self and identity. In view of the above, it is important to represent autistic adults who cannot conduct their own research, and thus autistic adults have been interviewed within this thesis. This gives autistic participants the opportunity to express themselves within research geared towards a possible intervention through which to develop their sense of self and identity. The rationale for this researcher stems from a 4 variety of personal and professional experiences. Having parents who are psychologists who have worked with autistic people in educational settings, an interest in working with autistic individuals was established early in my undergraduate years in university when I volunteered with adolescents who had a range of learning disabilities and special needs. During the three years of my degree in drama, I undertook projects within many of my modules that centred on drama with vulnerable adults, including those with autism, as it had occurred to me that drama was a potentially powerful vehicle for self-expression for such individuals who may have limited options for effective communication. Although at that time dramatherapy was no longer offered as a module as part of my course, the premise of the approach appealed to me as a form of therapy for adults who may have limited social skills and social awareness. After university, I worked as a drama specialist in a centre for expressive arts for vulnerable adults. Although not trained as a dramatherapist, and not working within a strict dramatherapy framework,